7 Serious Infections from Contaminated Food and Water

Recently, I watched a few episodes of “Naked and Afraid“, a series that puts two individuals in extreme environments with few supplies and, for some reason, no clothes. In this program, many of the participants come down with various infections; some of which cause bowel disturbances. Life then becomes, well, even more miserable than walking around for three weeks naked in the jungle.

Epidemics characterized by diarrhea and dehydration have been a part of the human experience since before recorded history. Cholera is an example of one particularly dangerous infection that was epidemic in the past. It and other bacterial diseases, many of which are now rare, may once again become a problem in the uncertain future.

Off the grid, water quality is questionable and may lead to misfortune if not properly purified. Using bad water to cook food in a remote setting can also lead to major problems that manifest as diarrhea, and later, dehydration. When dehydration is not treated, deaths may occur.

Many diseases with diarrhea as the main symptom are caused by poor sanitation. These including the following:

Cholera: Caused by CTX, a toxin produced by the marine and freshwater bacterium Vibrio cholera. Cholera toxins produce a rapid onset of diarrhea and vomiting within a few hours to 2 days of infection. This was a major issue in Haiti after the earthquake there several years ago.

The diarrhea caused by cholera looks like water after rice has been cooked in it. In addition, victims complain of nausea, leg cramps, and other symptoms. The body water loss with cholera is so severe that it is associated with a sixty per cent death rate if untreated. Aggressive efforts to rehydrate the patient, however, drops the death rate to only one per cent. Antibiotic therapy with doxycycline or tetracycline seems to shorten the duration of illness.

Typhoid (and Typhus): Salmonella typhi is a bacterium of the Enterobacteriaceae family that is found in contaminated and undercooked food. The illness it causes is called “typh-oid fever” because it often confused with Typhus.

Typhus is a complex of diseases caused by bacteria in the Rickettsia family that is transmitted, not by contaminated food and water, but by fleas and ticks in unsanitary surroundings. Although it rarely causes severe diarrhea, Typhus can cause severe dehydration due to high fevers and other flu-like symptoms. Five to nine days after infection, a rash begins on the torso and spreads to the extremities, sparing the face, palm, and soles. Doxycycline is the drug of choice for this disease.

Contamination with Salmonella in food (leading to typhoid fever) occurs more often than with any other bacteria in the United States, with a major outbreak in turkey meat causing more than 100 hospitalizations in 2011. In Typhoid fever, there is a gradual onset of high fevers over the course of several days. Abdominal pain, intestinal hemorrhage, weakness, headaches, and bloody diarrhea may occur. A number of people develop a spotty, rose-colored rash, hence the confusion with typhus. Ciprofloxacin  is the antibiotic of choice, but most victims improve just with rehydration therapy.

Dysentery: Caused by a number of different pathogens (disease-causing organisms), dysentery is an inflammation of the large intestine that presents with fever, abdominal pain, and severe bloody or watery diarrhea. Symptoms usually begin one to three days after exposure. Dysentery was a major cause of death among Civil War soldiers. It is a classic example of a disease that can be simply prevented with strict hand hygiene after bowel movements.

The most common form of dysentery in North America and Europe is caused by the bacteria Shigella and is called “bacillary dysentery”.  It is spread through contaminated food and water in crowded unsanitary conditions. Ciprofloxacin and Sulfa drugs, in conjunction with oral rehydration, are effective therapies.

Another type of dysentery is caused by an organism you may have read about in science class: the amoeba, a protozoan known as Entamoeba histolytica. Amoebic dysentery is more commonly seen in warmer climates. Metronidazole is the antibiotic of choice.

Traveler’s Diarrhea: An inflammation of the small intestine most commonly caused by the Bacterium Escherichia coli, commonly known as E. coli. Most strains of this bacteria are normal inhabitants of the human intestinal tract, but one (E. coli O157:H7) produces a toxin (the “Shiga” toxin) that can cause severe food poisoning. The Shiga toxin is so potentially dangerous that it has been classified as a bioterror agent.

In this illness, sudden onset of watery diarrhea, often with blood, develops within one to three days of exposure accompanied by fever, gas, and abdominal cramping. Rapid rehydration and treatment with antibiotics such as Azithromycin and Ciprofloxacin is helpful. The CDC no longer recommends taking antibiotics in advance of a journey, however, but does suggest that Pepto-Bismol or Kaopectate (Bismuth Subsalicylate), two tablets four times a day, may decrease the likelihood of Traveler’s Diarrhea.

Campylobacter: The second most common cause of foodborne illness in the U.S. after Salmonella, this bacterium resides in the intestinal tract of chickens and causes sickness when meat is undercooked or improperly processed. It’s thought that a significant percentage of retail poultry products contain colonies of one particular variety, Campylobacter jejuni. Symptoms include bloody diarrhea, fever, nausea, and cramping which begins two to five days after exposure. Although controversial, Erythromycin may decrease the duration of illness if taken early.

Trichinosis: Trichinosis is Caused by the parasitic roundworm Trichinella in undercooked meat, mostly from domesticated pigs. Trichinosis causes diarrhea and other intestinal symptoms one to two days after exposure. Fever, headache, itchiness, muscle pains, and swelling around the eyes occur as much as 2 weeks later. Recovery is usually slow, even with treatment with the anti-helminthic drugs Mebendazole and Albendazole (Albenza).

Giardiasis: The most common disease-causing parasite in the world is the protozoa Giardia lamblia. It has even been found in backcountry waters in many national parks in the U.S. Symptoms may present as early as one day after exposure, although it more commonly presents in one to two weeks. Patients complain of watery diarrhea, abdominal cramping, violent (often called “projectile”) vomiting, and gas. Metronidazole is the drug of choice in conjunction with oral rehydration.

There are many other pathogens that can cause diarrheal disease and dehydration if untreated. Although we have listed antibiotics in this article (many of which you can read about in this website), most of the above will resolve on their own over time with strict attention to oral (or intravenous) rehydration. Without hydration support, however, the situation may become life-threatening in some cases.

An important point is that some of these illnesses may be mimicked by viruses that are unaffected by antibiotics, such as norovirus, so employ them only when absolutely necessary. The U.S. is in the midst of an epidemic of antibiotic resistance that is partly due to overuse in humans. You might be surprised when I say “partly”; close to 80% of antibiotics in the U.S. are given, not to humans, but to food-producing livestock.

If you see post-apocalyptic disaster movies, you’ll see a lot of gunfights at the OK corral. Certainly, this may occur in the aftermath of a major catastrophe. The most deaths will occur, however, due to failure to assure that water is clean, food is prepared properly, and human waste is safely disposed. The medic for a survival group must understand this and enforce good sanitary practices. If he/she is successful, the group will have a better chance of staying healthy even in the worst of situations.

Joe Alton MD